Diagnostic Challenges of Coccidioidomycosis in Solid Organ and Hematopoietic Stem Cell Transplant Recipients

Purpose of Review The goal of our manuscript is to address the diagnostic challenges in coccidioidomycosis related infections among solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients. We hope to answer the utility of different methods in reaching the diagnosis and tackle each test’s limitation in SOT and HSCT recipients. Recent Findings Multiple testing modalities including serology, antigen, PCR, and β-d-glucan (BDG) tests are performed during the evaluation process of SOT/HSCT recipients with coccidioidomycosis. We have highlighted recent literature discussing the sensitivity and specificity of these tests in SOT/HSCT recipients. Summary We have found that the best approach to diagnosing transplant patients with suspected coccidioidomycosis, is to utilize multiple testing modalities including serology, antigen, PCR, and BDG tests, which can lead to earlier and improved test sensitivities. This approach is important as there is a high risk for the transplant patients who may not mount appropriate immune responses for the serology tests to become positive, resulting in the progression of undiagnosed and untreated infections. Future testing is required to further evaluate and validate newer diagnostic testing such as PCR in the diagnosis of coccidioidiomycosis.